Although the language of the Affordable Care Act places considerable emphasis on disease prevention - for example, mandating insurance coverage of clinical preventive services such as mammograms - funding for public health programs to prevent disease have actually been declining in recent years, researchers say.

"Per capita public health spending (inflation-adjusted) rose from $39 in 1960 to $281 in 2008, and has fallen by 9.3 percent since then," write Drs. David Himmelstein and Steffie Woolhandler in the American Journal of Public Health. "Public health's share of total health expenditures rose from 1.36 percent in 1960 to 3.18 percent in 2002, then fell to 2.65 percent in 2014; it is projected to fall to 2.40 percent in 2023."

Their article, titled "Public Health's Falling Share of U.S. Health Spending," draws on five decades of data from the National Health Expenditure Accounts compiled by the U.S. Department of Health and Human Services and from the U.S. Census Bureau.

Dr. Himmelstein, a professor at the City University of New York (CUNY) School of Public Health at Hunter College and lecturer in medicine at Harvard Medical School commented: "Obamacare was supposed to add $15 billion to public health funding. But in 2012 Congress cut that by $6.25 billion, and sequestration imposed further cuts in 2013. This year, public health will get less than half of the $2 billion promised by the ACA. And state and local government public health spending has also fallen, even while their other health expenditures have continued to rise."

Dr. Woolhandler, a primary care doctor in New York City, professor at CUNY's public health school at Hunter College and lecturer at Harvard Medical School, said: "Our health care system is dangerously out of balance. We're spending more and more treating disease, but less and less to prevent it."

The authors note that if the nation's inflation-adjusted public health funding had remained at the 2008 level ($281 per capita), an additional $40.2 billion would have been devoted to public health between 2009 and 2014.

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In addition to their academic posts and clinical work, Himmelstein and Woolhandler are co-founders and leaders of Physicians for a National Health Program, a nonprofit organization that advocates for a single-payer health system. PNHP had no role in funding their study.

"Public Health's Falling Share of U.S. Health Spending." David U. Himmelstein, M.D., and Steffie Woolhandler, M.D., M.P.H. American Journal of Public Health, embargoed until 4 p.m. Eastern time on Nov. 12, 2015.

Physicians for a National Health Program is a nonprofit research and education organization of more than 20,000 doctors who support single-payer national health insurance. PNHP had no role in funding or otherwise supporting the study described above.

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